Reports from Haiti

Even though I’ve been back in the states for almost a week now, the events of last week are just too exciting not to blog about.

When BTB project coordinator Janet arrived in Thomonde last Wednesday to check up on our internship projects and transport us back to the U.S., Kelly and I were astonished to find out that Jeffrey Sachs, Sonia Sachs, and an entire UN delegation were planning to visit Project Medishare the next day!

I don’t think I’ve mentioned this in my previous blogs, but one of the villages where Project Medishare’s team works, Marmont, has been selected by the Earth Institute as a Millennium Village. It is the first Millennium Village in the Western Hemisphere. The goal of the Millennium Village Project is to improve the health, agriculture, economy, etc. in one impoverished village at a time in a developing country. The villages are designed to demonstrate how the Millennium Development Goals can be achieved through community-based development.

Early Thursday morning, about 30 conference attendees arrived at Project Medishare’s compound and we began a tour of Marmont’s various development projects.

Our first stop was at the construction site for the Akamil Production Facility and the Childhood Nutrition Treatment Center. Akamil is an oatmeal-like substance (we actually tried it at lunch—it’s good!) fortified with vitamins and minerals, which will be produced locally in order to decrease the prevalence of malnutrition in the area.

Next, we drove up Mourne Sourit to take in a view of Marmont. We could see Thomonde, Hinche, and the surrounding area.

We then met a group of farmers under a tall tree at the bottom of the hill, where we witnessed a dialogue between Jeffrey Sachs and local Haitian farmers. He asked the farmers what kind of crops they grew, where they obtained water, if they had enough water, what they thought the government and other non-governmental organizations could provide for them, etc. He also specifically asked the women, “Do you have enough food?”, and the women in the crowd quickly and in unison answered, “No.”

It was an incredible opportunity to observe this conversation between Jeffrey Sachs and the farmers. It’s one thing to hear such an important figure in international development speak, but to be able to listen in on a conversation between Jeffrey Sachs and everyday Haitian farmers, and really see Jeffrey Sachs in his element, is truly a one-in-a-lifetime opportunity.

The delegation then took a quick tour of the clinic in Marmont and the Maternity Ward construction site, which is expected to be completed in December. A dormitory-like building is also under construction directly behind the ward, which will house physicians and staff so that they can provide 24-hour care for women.

(Dr. Green, Dr. Fournier, Professor Jeffrey Sachs, Dr. Greig, Dr. Malou, and Dr. Sonia Sachs in front of the Maternity Ward site)

When we arrived back at Project Medishare headquarters, Kelly and I had hoped to demonstrate at least one of the backpacks to any of the conference attendees, but we knew that they were on a very tight schedule and understood that we might not get the opportunity due to time restraints. Dr. Arthur Fournier, co-founder of Project Medishare, was able to gather a few people to view the Diagnostic Lab-in-a-Backpack, however, and Kelly and I were thrilled to give a quick demo of the backpack. Dr. Fournier and Dr. Sonia Sachs were very impressed with the backpack and were able to provide us with valuable feedback as well.

(Dr. Fournier, the representative for the Haitian Prime Minister, and Dr. Sonia Sachs examining the user manual of the Diagnostic Lab-in-a-Backpack)

As quickly as they came, the delegation departed for Port-au-Prince, and it was hard to believe that all of the day’s events had actually happened. From schoolchildren, to medical students, to Jeffrey and Sonia Sachs, Kelly and I have certainly met a wide range of interesting and inspiring people in Haiti!

Since this is my last blog, I want to thank Beyond Traditional Borders, Bethlehem Ministries and the staff and students at St. Barthelemy, Project Medishare, Janet Wheeler, Kelly, and all of the incredible people I’ve worked with at Rice and in Haiti for providing me with this amazing opportunity.

A quick story on how the past year’s events have come full circle for me: just last summer, I happened to read a book about a doctor in Haiti, Mountains Beyond Mountains. I came across the name of a hospital that sounded familiar, and after talking to my mom, I realized that it was the same hospital she had worked at over ten years ago. Thus began my initial interest in global health. Soon after, I also happened to read The End of Poverty, by Jeffrey Sachs, which further spurred my interest. In the fall, I eagerly signed up for a Bioengineering and World Health course and took a subsequent course in the spring. Only one year later, I find myself living and working in the settings of these books, meeting the people I’ve read about and experiencing the country I’ve heard about for years, and even meeting one of the authors. I wouldn’t be exaggerating to say that this experience has been a dream come true.

In many ways, this internship has felt like the culmination of months of preparation and work, and it has been, but I also know that this is just the end of a beginning. As a rising senior who’s still unsure about life after graduation, I went into this internship expecting to figure out which post-grad road to take, but I’m surprisingly as uncertain as ever. I’ve experienced the hope in teaching children who otherwise would not receive an education, witnessed the joy in providing sight to the blind, felt the excitement in building devices that improve the health of those most in need, and enjoyed the adventure of traveling and experiencing a new culture. A year ago, I never would have expected to be where I am now, so I’m not too worried about the future—I know it will work out even better than I can imagine.

Thanks for reading! I hope you enjoyed reading about my adventures in Haiti as much as I enjoyed writing about them.

This post’s title pretty much sums up the past week in Thomonde. Kelly and I had the opportunity to tag along with the medical team from Morehouse School of Medicine on their mobile clinics, which was very interesting and enjoyable (sidenote: approximately 99% of the Americans I’ve met in Haiti are from Georgia, including Kelly, so I’ve come to the conclusion that Georgians are slowly taking over Haiti. Don’t be fooled by their innocent Southern accents; they’re definitely up to something). Our daily commutes to the clinic sites were an experience themselves, as we had to drive for up to 2 hours through the hills, valleys, and streams of the Central Plateau to reach our various destinations.

But let me backtrack a little: last Monday, we left Terrier Rouge (a bittersweet goodbye) and flew from Cap Haitien to Port-au-Prince. After spending six weeks in Northern Haiti and visiting Cap Haitien several times, I actually felt some reverse cultural shock when we arrived in Port-au-Prince. While I’m sure the area that we drove through was a nicer part of the city, Kelly and I were both surprised at the relative cleanliness and consideration for traffic laws. We even saw several traffic lights.

After meeting up with the team of med students, MPH students, doctors, and nurses from Morehouse, we headed to Thomonde, via the most winding, edge-of-the-cliff road I’ve ever driven on (and considering I grew up in Pittsburgh, the capital of ridiculous road systems, that’s definitely saying something). I can’t even begin to describe the amazing view along the way, so I’ll try to upload some photos in a later post.

Even though I’ve read Mountains Beyond Mountains (like many global health enthusiasts) and tried to imagine the bumpy Rue Nationale 3, the beautiful Lac du Peligre, and other features of the Central Plateau, nothing can compare to seeing it in person. It was like seeing a movie version of one of your favorite books, but in real life and ten times better!

The first night in Thomonde, Kelly and I got to know the medical team, realized just how much we missed conversations in English, and tried to help out with some basic Creole translations. While I really haven’t learned as much Creole as I probably should have after spending six weeks in Haiti, Kelly and I are pretty adept at Creole pronunciation, so we did our best to write out some phonetic Creole (i.e., “M’rele” became “mmm ray-lay”). If all else fails, Kelly and I can start our own phonetic Creole translation business after graduation.

Tuesday through Friday, we drove to four different villages and watched the team quickly transform various churches/schoolhouses/shaded trees into functioning triage, pediatric, ophthalmologic, OB/GYN, and internal medicine stations. Because the team treated hundreds of patients each day and had to make quick, gut-reaction diagnoses, the diagnostic backpacks Kelly and I brought were not applicable to their work, but we were able to observe how a mass-scale mobile clinic works and understand both the challenging and rewarding aspects of such work.

A patient being fitted for glasses

While many patients received medical care that they would otherwise have never received, and some critical patients were referred to the closest hospital for life-saving treatment, there were some obvious limitations to the mobile clinic as well. Patients with end-stage cancer, ectopic pregnancies, Turner’s syndrome, or other difficult/life-threatening/genetic conditions were given their diagnosis, but treatment was out of the scope of the clinic.

Lines of patients waiting to see the ophthalmologist and internist

Observing the mobile clinic work also gave me a whole new appreciation for health prevention and the health and hygiene lessons we taught in Terrier Rouge. I can only hope that our lessons on hand washing, teeth brushing, malaria and typhoid transmission, etc. at St. Barthelemy will prevent at least a handful of clinic visits in the future.

Kelly and I probably spent the most amount of time at the pediatric station, where we measured kids’ arm circumference, height, and weight. Many of the patients suffered from malnutrition, and several times I did a double-take when I read a child’s age on their chart after taking their weight—I might not have a medical degree, but I do know that a 3-year-old should never weigh 18 lbs.

We also tried to help translate at the triage station by asking patients, “Ki kote ou fe mal”?,” which means, “Where does it hurt?,” so that they could be referred to the proper station for further diagnosis and treatment. It was rather shocking how many patients, after saying that their stomach hurt, subsequently said, “M’grangou,” which means, “I’m hungry.”

It reminded me of a quote in Mountains Beyond Mountains that giving medicine but not food is like “washing your hands and drying them in the dirt.” Not that I advocate handing out food necessarily, but the fact that many patients needed the simple treatment of “food” surprised and saddened me. The food shortage in Haiti struck me even more during our drive to Hinche. We saw street vendors selling bagged dirt, and one of Medishare’s doctors explained that Haitians use the dirt to make “dirt pies” that they actually eat. I don’t think I’ll ever look at dirt, or pie, the same way again.

I actually felt the most useful when Kelly and I were given a portable photo printer that the team had brought in lieu of the no-longer manufactured Polaroid camera and film. Throughout the clinic on Thursday and Friday, we took photos of mothers with their children at the pediatric station and gave them a print to keep. It put a smile on my face to see the mothers’ smiles when they saw the photo of them with their children. In a country where many people do not even know what they look like because they can’t afford a mirror, something as simple as a photograph can mean so much to someone.

The portable photo printer.... a nice mobile clinic novelty

My favorite mom-child photo 🙂

Overall, I really enjoyed our time at the mobile clinics, and being able to observe and work with such a gracious and fun team of students and doctors made the past five days some of my most memorable and enjoyable in Haiti.

This is our last weekend in Terrier Rouge and I’m finding it hard to believe that our time in Haiti is coming to a close so quickly. I’m really looking forward to the next two weeks at Project Medishare in Thomonde, but St. Barthelemy has grown on me more and more over the past six weeks and it’ll be hard to say goodbye to the amazing students, teachers, and staff here.

I know that most of my posts so far have focused on my outward experiences and observations in Haiti, and I’ve avoided delving into a lot of my own personal thoughts and emotions. It’s easy for me to describe what I’ve seen and heard, but to describe what I’ve felt seems nearly impossible. Every conversation, interaction, and experience I’ve had in Haiti elicits more thoughts and emotions than I could even begin to describe. It’s almost as if I would need some sort of stock exchange-like live update attached to my blog: Jocelyn is hopeful… Jocelyn is nervous…. Jocelyn is thrilled…. etc. to show my “thought of the minute.” Even though I’ve been in Haiti for six weeks, I feel like I’m just beginning to process my time here.

Thursday’s adventures, however, allowed me to gain a new perspective on Haiti, literally and metaphorically, so I’ll do my best to tie together a narrative of the day and how it represents one of the overarching themes of my experience so far:

At the crack of dawn, Kelly, our translator, and I packed into one of the school’s SUVs and made our way to Milot, via Cap Haitien and a few other modes of transportation (for the sake of my parents’ blood pressure, I’ll leave it at that). When we arrived in Milot, we made our way to the center of town to begin our ascent up the mountain, on top of which the Citadelle, the largest fortress in the Western Hemisphere and one of Haiti’s most famous landmarks, is located.

(the Citadelle is the square-shaped structure in the center of the photo)

After some tough monetary negotiations with a rather questionable “official” tour guide (at times, the Haitian gourde-Haitian dollar-American dollar conversion has required some long division!), we made our way up the mountain via another mode of transportation and on foot. At one point, I began to wonder why we thought climbing one of the highest mountains in Northern Haiti in July was a good idea, but once we arrived at the Citadelle and took in the spectacular view, I realized it was more than worth the climb.

I felt like we were on top of the world—I could see in every direction for miles, from the bay of Cap, to the Grand Rivière in the valley, to the mountains in the South. It was truly one of the most incredible sights I’ve ever seen.

According to a plaque we read inside the fort, the Citadelle was built by King Christophe to defend Haiti against French invasion. In 1820, the king committed suicide after a mutiny arose, and although his body was returned to the Citadelle, to this day, no one knows where his remains lie in the fortress (future Pirates of the Caribbean/Indiana Jones movie plot? I think so).

On our way back down the mountain, we also explored the ruins of Sans Souci, King Christophe’s palace.

The completely different views from the base and the top of the mountain reminded me of the different perspectives I’ve had during my work at the school and clinic. Many times, I’ve had a “base of the mountain” view of my work, but seeing my work from a larger, “top of the mountain” perspective is so much more rewarding.

Some days, I felt so overwhelmed by all of the kids and their bottomless energy in the mid-day heat. I sometimes wondered how we would manage to teach and encourage healthy behaviors in children who are surrounded by anything and everything that inhibits good health. But then I see kids like 6 year-old Didi, who has a smile that could stop an army, and 12 year-old Francisca, who asks such thought-provoking questions, and their smiles and questions remind me why we’re teaching and how fortunate I am to play a role in their education. This experience is not about the insignificant, day-to-day frustrations I may complain about; it’s about passing on some of the knowledge that I’ve been so blessed to receive in my life to the kids whose lives can be changed with such knowledge.

During our work in the clinic, it can be so easy to fall into the negativity trap when a patient’s file has two different reference numbers, or when the language barrier between you and the technician seems momentarily insurmountable. But no matter how confusing the filing system and conversations may be, I try to remember that these patients are so fortunate to even have medical records at all, and the fact that I am participating in their medical care, even in the smallest way, is a huge privilege and valuable learning experience.

So I’m trying to view every obstacle and challenge as part of the overall picture, and to not get caught up in the smaller, momentary frustrations that come with living and working in an unfamiliar place. I think it’s important to gain both perspectives, but the view from the top, while a lot more difficult to reach, allows you to fully appreciate and understand the view from the bottom.

St. Barthelemy’s kindergarten and 6^th grade graduation is tomorrow, and then Kelly and I leave for Thomonde Monday morning, so my next blog will most likely be from Thomonde. This weekend will definitely be our busiest yet.

Happy Fourth of July!

The mobile clinic last Saturday was definitely one of the highlights of my time in Haiti so far.

Setting up the mobile clinic in Phaeton

I know Kelly described the clinic in detail already, so I’ll just add a few of my own observations while working with Dr. Lucien.

Kelly and Josenide examining a hematocrit sample

A majority of Dr. Lucien’s patients, about 25 total, received post-op care after having cataract surgery over a month ago. She performed surgeries in only one eye per patient in order to minimize risk of infection and complications (I think this is the standard procedure for all cataract surgeries).

While Dr. Lucien brought several of her own supplies on the trip, she was also able to use the equipment in the diagnostic eye pack as well. Our main goal in bringing all of the backpacks to Haiti is to observe their use by physicians and receive feedback in order to improve upon the designs.

The exam protocol was similar for each patient. Dr. Lucien’s assistant first checked patients’ visual acuity with a vision chart in the front of the building, and then Dr. Lucien examined patients in a room away from sunlight. She examined the patients’ treated and untreated eyes with a direct ophthalmoscope, slit lamp, headlight, and penlight. I was able to view a few of the patient’s intraocular lenses that were implanted after the removal of the cataract with the slit lamp, as well as the patients’ clouded cataracts in the untreated eyes.

Paul, Dr. Lucien's assistant, performing vision tests

After visually examining the eyes, Dr. Lucien numbed some of the patients’ eyes with medication and used a tonometer to measure the intraocular pressure of the eye. In one case, the patients’ pressure was very high, which indicated glaucoma. Dr. Lucien explained that this was why the patient’s surgery was not nearly as successful as it could have been because of his underlying glaucoma condition.

Dr. Lucien examining a patient with the portable slit lamp

Another particularly interesting case involved a non-cataract patient. A middle-aged gentleman had difficulty seeing in his right eye, but the reason for his poor vision was not immediately obvious. Dr. Lucien applied drops to dilate his pupil, and after examining him again she noticed that he had scarring on his retina and prescribed him with medication.

While post-op complications seemed to be minimal, the joy of regained sight was infectious. When Dr. Lucien asked one woman how she was doing since her surgery, she replied, “M’ap danse!,” which means “I’m dancing!” in Creole. Another woman said “Grace à Dieu, grace à Dieu” several times, meaning “thanks be to God,” for her restored sight. There were many other comments made by the patients, but I could only translate the relieved and grateful looks on their faces.

I cannot imagine how it must feel to have sight restored after months or even years of blindness. While working on my project during the school year, I learned that in places like Haiti and other developing countries where surgical eye care is not readily available, a vast majority of people with cataract accept their blindness as a permanent condition and learn to live with it. Dr. Lucien’s work in Haiti is a testament to the fact that Haitians should not and do not have to learn to live with treatable blindness.

I could not ask to observe and work with a more respectable and adaptable physician. Dr. Lucien managed to see 25 patients in less than 4 hours while dealing with sweltering heat, chickens strolling through the exam room, equipment malfunctions, and other interruptions and distractions. It was certainly a sight to behold (and thanks to her skillful work, her patients could!).

Kelly and I sporting the backpacks. Huge hit on the medical fashion runway 🙂

Since the mobile clinic last week and the end of school, Kelly and I have been working on various small projects to prepare for the graduation next Sunday. We’ve also been assisting one of the technicians at the clinic with the entry of electronic medical records.

I think I can speak for Kelly, too, when I say that we miss the kids dearly. We’ve still got our rooster, donkey, and cow neighbors to keep our little Haitian countryside symphony going, but it’s oddly quiet at 8 in the morning without 600 kids outside of our window.

Also, I was a little under the weather after the clinic, but I’m feeling 100% better now thanks to Kelly and the school staff’s attentive care. I’m pretty sure the entire town of Terrier Rouge knew I was sick. No, really: I saw our translator on Tuesday, after not seeing him since last Friday, and he knew I had been sick, and another preschool teacher asked me if I was feeling better too. Word travels fast around here!

A few visitors and relatives of the Brunos are in town this weekend for the St. Pierre (Terrier Rouge’s patron saint) festival, so it should be an exciting and busy weekend.

Today was the last day of school, and we couldn’t have asked for a better way to finish off the year than by demonstrating the Capteur Soleil to the 6^th grade class.

Jean, Dr. Schuler, Richard (who works at the school), Josef (our translator), Kelly and I all visited the 6^th grade class, and Dr. Schuler and Richard explained how the Capteur works.

It was especially exciting to see Richard up in front of the class, drawing diagrams on the board and asking the students questions. Jean told us that Richard assembled a lot of the Capteur himself, so it’s really great to see a school employee take ownership of the device and share his knowledge with the students. It’s one thing if we, as the out-of-place foreigners, are excited about the project, but it’s even better if students, teachers, and staff at the school show interest in it as well.

After a brief lecture in the classroom, we all made our way down behind the school to see the Capteur in action. The kids seemed quite amazed by the UFO-like device that “landed” behind their school just this past week.

Some of the students put their hands near the top of the device, where the sun’s rays, bouncing off the mirrors, are concentrated, and they could feel the increased temperature. This seemed like a great way for them to conceptualize the idea of light being converted to heat.

Richard poured some water into a tube, which traveled up to the “concentrator” part of the device. The sun’s rays, focused at the “concentrator,” converted the water to steam, the steam entered a cooking pot, and food in the pot was cooked. We actually ate some potatoes that were cooked in the Capteur the other day (“pommes de terre du soleil”, as Jean called them), and they tasted even better than usual.

I’m just amazed that, in only 5 days, Jean and Dr. Schuler have been able to transport, assemble, and complete a functioning device as complicated as the Capteur Soleil. I feel so lucky to be present for such a momentous occasion.

Speaking of momentous occasions, we will be participating in the mobile clinic with Dr. Lucien, Dr. Gustave, and the whole traveling medical team tomorrow! I can hardly wait to see the backpacks in action. After nearly a year of planning, discussing, and designing the diagnostic eye pack, with many bumps in the road and changing directions, it will be a dream come true to see the pack used for its intended purpose. I only wish it were possible for everyone who has contributed to the Diagnostic Lab-in-a-Backpack, Community Health Worker Backpack, and Diagnostic Eye Pack to see the results of their work as well, although there are probably too many people to count.

Our work at the clinic has begun to pick up this past week. On Thursday, we helped the technicians organize medical records. Patients’ files are ordered numerically and the number is matched to the patient’s name in a spreadsheet. We had some initial confusion about the record system because some numbers were accidentally used for multiple patients, and a lot of the names sounded very similar (for example, there were files for twins named “Josenide” and “Josemide”… as a twin myself, I would just like to thank my parents for giving my sister and I very different names!).

Kelly and I also observed that the techs were not using the Excel program as optimally as they could have, so we’re hoping to show them a few pointers if time allows. The techs were really friendly and interested in learning English, and I’m excited to continue working with them.

I also spoke to Dr. Lucien and Dr. Gustave about the lab protocols (Gram staining, hematocrit, urinalysis, etc.) that can be performed with the Diagnostic Backpack. They were interested in having the technicians read and become familiar with the protocols, but because the directions are only in English, I suggested that Kelly and I could translate the directions to French. Between the two of us and our translator, we hope to translate as much as possible before the mobile clinic on Saturday (5 days! I can’t wait!).

On Friday, we taught a bone and dental hygiene lesson to the lower grades and a malaria and typhoid transmission lesson to the upper grades.

We discussed how we have 206 bones in our body, where the main bones in our body are located (cue Kelly’s amazing skeleton poster), how our teeth are a type of bone, and how and why we brush our teeth. When we asked them how long we should brush our teeth, we got some really funny answers, like 52 minutes, 2 hours, and other rather lengthy amounts of time. Kelly and I realized that the hand washing song is ~30 seconds, so if you brush your teeth while singing the hand washing song 4 times, it’s a pretty good teeth-brushing timer (4X in 3 classes + teaching the song 2 weeks ago = we are now singing the song in our sleep. That, on top of chloroquine, makes for some very interesting dreams).

We had other amusing replies to the question, “What do we put on our toothbrush?” We were hoping to hear “clean water” and maybe a few “toothpaste” answers, but the entire class replied, in unison, “COLGAT.” Apparently Colgate has strong branding strategies in Haiti.
The 6^th grade lesson was really interesting and fun, as always. Kelly and I intended to tie together the germ transmission lesson and cell lesson into a disease transmission on a cellular level lesson. We used sheets of paper to depict the sequence of both typhoid and malaria transmission, with purple glitter representing the typhoid bacteria and silver glitter to representing the malaria parasite (as you can tell, glitter might be our most popular teaching tool). After we explained each step in the transmission process for each disease, we asked several students to hold the papers in front of the class, put the transmission steps in order, and explain the events of each step.

As a visual learner with nonexistent artistic ability, I think it’s been helpful to show a few images on my computer of whatever cell/bacteria/parasite we’re discussing so that the students have a better mental picture of the concept as well.

The students asked a lot of really great questions, like “what kind of mosquito carries the malaria parasite?,” “can you get malaria from eating from the same spoon as someone who has malaria?” and, “can you get malaria if blood from an infected person gets into a cut in your skin?” (which led me to ponder their knowledge of HIV, but that’s a whole other summer’s worth of material…). I love the question/answer part of our lesson; it’s almost like I can see the wheels turning in the students’ heads.

For me, this lesson was one of the most rewarding parts of our teaching experience so far. To hear the students explaining the function of red and white blood cells, the importance of hand washing, the affect of germs on our body, all in one class period, was like seeing pieces of a puzzle finally fit together. It’s still a work in progress, and we might have lost a few pieces and jammed a few pieces into the wrong place, but I can start to see the overall picture.

We had a fairly uneventful weekend, with the exception of Dr. Schuler, a Rice professor at the Jones School, and his father-in-law, Jean Boubour, arriving on Sunday to begin their Capteur Soleil project, which is a type of solar device used for cooking, medical instrument sterilization, and other heating applications. Kelly and I were particularly excited about a potential soap-making application as well, as we’ve noticed the lack of soap in the school’s bathrooms, and we’ve considered initiating a soap-making project with some of the older students once school is out.

While helping with some of the assembly of the device this afternoon, we’ve discovered an addition to the list of “Things Kelly and Jocelyn Do That the Haitians Find Hilarious” (eating mangoes being first on the list): using screwdrivers, hammers, or any other tool. One of the kitchen ladies watched us struggle with a bolt for a few minutes, laughing to herself at the phenomenon of women using tools. For our next act, maybe we’ll play soccer with the boys. While wearing pants 😉

No, it’s not actually snowing in Haiti: we learned weather and seasons in our English/Creole class yesterday, and Kelly and I were surprised to find out that there is, in fact, a word for snow in the Creole language. But I bet the title made you want to keep reading 😉

As I finish my second full week of teaching here at St. Barthelemy, I thought I’d reflect on some of the challenges Kelly and I have faced and how we’ve tried to overcome them. I’m optimistic about our work at the school, and I hope that my blogs so far have conveyed this outlook, but I definitely don’t want to give the impression that teaching kids is all fun and games. It’s been really enjoyable at times, but also very difficult at times. A few lessons I’ve learned so far:

Teaching is hard.

I feel like I have a whole new appreciation for every teacher I’ve ever had. Standing in front of a room full of students and trying to get across an idea verbally or visually is quite daunting, especially for someone like me who’s more of a behind-the-scenes kind of person. It’s one thing to understand a concept that you’ve known for years, but to explain it to a room full of kids who’ve never heard of the concept is completely different.

Teaching in a different language is even harder.

Not only do we have to teach health and science concepts to the students, but our translator, who is a native Terrier Rougian (not quite sure how to say that?), is not familiar with a lot of the concepts either. Before class, we have to make sure that he understands the concepts well enough to translate the ideas and related vocabulary. I’ve learned to avoid jargon-y phrases like “made up of cells” and use more easily translatable phrases like “composed of cells,” or use “eliminate germs” instead of “get rid of germs.”
I’m also learning that many words just don’t translate from English to Creole. In the 3^rd grade class the other day, we discussed red blood cells and their ability to transport oxygen. The teacher asked a question about “glob rouge,” and my college-educated mind jumped to the word “hemoglobin,” and for a minute I was really excited to talk about heme groups and iron and all of that nerdy stuff… and then I realized that he probably just meant “red blood cells.” I don’t think the term “hemoglobin” actually exists in the Creole language.

Teaching requires a level of energy that is nearly impossible at 8 am.

(For those of you who’ve dealt with me in the morning, you can imagine how particularly difficult this is for me!)
Even though we’re speaking in English and the students have no idea what we’re saying, we still have to sound enthusiastic about the lesson. And one thing that all kids have in common, regardless of nationality or age, is that monotone lecturing will lose their attention in less than 5 seconds. So we try to sound as excited as humanly possible about water purification and hand washing.
By the way, Kelly is a saint for being so chipper during the English lessons. After several hours with hundreds of kids, I just don’t have it in me to get as excited about greetings and numbers as I do about cells.

Students tend to take things very literally.

When we tried to explain how germs take water and nutrients from our body, we used a water bottle and mango to represent the body’s water and nutrients. The 6^th graders, however, only saw a water bottle and mango, and they thought we were trying to show how to wash fruit before eating it. The next time we taught the 6^th grade, we made a diagram (see below) showing a microbe taking a cell’s water (drawn as a water drop) and nutrients (drawn as green dots). I considered drawing a banana or bread inside the cell to represent nutrients, but Kelly pointed out that we’d then have a bunch of 6^th graders who think there are bananas and bread in cells…. bad idea.

Basic science concepts are fun!

By far, our best lesson yet was the cell lesson we taught the 4^th, 5^th, and 6^th graders this week. When we explained the different kinds of cells (see Kelly’s post for details), it was kind of like describing different characters in a story, each with their own roles and personalities. When we explained how white blood cells attack invading microbes, it was very convenient that leukocytes really do eat foreign bodies (see my Pac man-like drawing above). When we explained that some neurons in our body can be up to one meter long, our translator told the class that we exaggerate a little, but we corrected him and emphatically said that it’s true. Forget fairy tales and monsters—cells are just as cool! So I’m learning that science topics, especially concerning the human body, can be really interesting if taught in a narrative fashion.

Limited resources make not only teaching, but learning, even more difficult.

As a product of American education, I’m beginning to realize just how spoiled I’ve been for the past 18 years. I learned with play-doh, coloring books, educational CD-ROMs, and Sesame Street. Kids in Haiti learn with… chalk, one notebook, and a few posters around their classrooms. The fact that St. Barthelemy teachers are able to teach their lessons with such limited resources, and that the students try so hard to learn with only a chalkboard and their own imagination, absolutely amazes me.
The weekend before I came to Haiti, I was visiting family in Nashville, and my aunt showed us around the exhibits in the Nashville Science Center to which she contributed (hi Aunt Tina!). One of exhibits, Body World, had a huge, beating heart to show how the circulatory system works, and a larger-than-life set of lungs to show how the respiratory system works. I can’t even imagine how much the kids at St. Barthelemy would love to see such an exhibit and how much it would improve our health lessons.

On Tuesday, Kelly and I began teaching English to the teachers! We’ve covered basic greetings, numbers, and the family so far. After we taught the vocabulary in English, the teachers taught us the vocabulary in Creole. It’s been a great way for us to interact and bond with the teachers. The teachers’ enthusiasm inspires me to learn Creole as well.

When we taught the 6^th grade class, Kelly and I noticed that the students have misconceptions about malaria. They seemed to believe that diseases like typhoid, the common cold, and malaria came from microbes in water. When our translator showed us the water pumps around Terrier Rouge, even he said that you can get typhoid or malaria from the water. I think we’ve found another topic to cover, to say the least!

Yesterday, we had a busy morning with the preschoolers and kindergarteners. We tried our best to teach them the hand-washing song, but to be honest, they were really distracted by our presence—as Kelly and I walked around the classroom, singing the song and showing the hand motions, they stopped singing and just stared at us as we came closer. It seems as if the 3-year-olds have a 3-second attention span, the 4-year-olds have a 4-second attention span, etc…. Next week, we’ll have to find some activities that are a little more engaging.

In the afternoon, we demonstrated the Diagnostic Backpack to Dr. Gustave, who was very impressed with the backpack as well.

Best news of the week—there will be a mobile clinic tentatively on Saturday, June 20^th, with Dr. Lucien and Dr. Gustave, in which we will participate and see the backpacks in action! It’s great that the doctors are willing to take time out of their weekend to run a mobile clinic and test the prototypes.

We also briefly heard about the clinic’s community health workers who go door-to-door administering basic treatments and medications. They may even follow the DOT system (Directly-Observed Therapy), which is used for TB, HIV, and other types of patients on strict medication regimens in order to prevent drug resistance. Kelly and I hope to observe their work at some point and see if we could make any contributions or improvements to their work in Terrier Rouge.

Today was thought-provoking day for Kelly and I, as well as the kids. Our next round of lessons focuses (ha ha) on the microscope and how to view microbes in the microscope. In the first 1^st grade class, we had a few technical difficulties (even your basic microscope can stump a couple of college students…. after much head scratching, we decided to pull out the directions!), but we quickly fixed the problem and showed the class the “meekwobes,” as they pronounce it. They watched the microbes swim across my computer screen (we had a small camera attached to the eyepiece so they could view the microbes on a larger screen) and were fascinated by their movement. I think it was especially interesting to them because the water containing the microbes looked very clean.

After all of the students saw the swimming microbes, we added Clorox to the water sample, and the students then observed the immobile microbes.

In the 2^nd grade class, we also had time to introduce the concept of cells, explain what they are, and how we have millions and millions of cells in our body (we figured that the word “trillion” might be confusing). We ran out of time to swab our own cheek cells and show them in the microscope, but we hope to try it on Monday with the upper grades.

Here are a few photos taken over the past two weeks:

On Thursday and Friday, Kelly and I began teaching in the classes. We decided to combine the hand washing lesson and song with a more interactive demonstration using glitter to represent germs.

Before we met with the 4^th graders, we discussed the lesson with our translator. I was worried at first about not being able to fully convey the purpose of the lesson to him, but he caught on quickly. There was definitely a light bulb moment when he understood how students shaking hands with other students who have glitter on their hands represents germ transmission.

The 4^th grade class was very receptive to our lesson! Our translator is a natural in front of a classroom, and he even elaborated on our main points and asked the students, “Do you understand?” several times. We explained that germs are small and we can’t see them, and that they make us sick, but we can get rid of them by washing our hands with soap and water (I can still hear the French and Creole words in my head … Freole?).

Kelly and I pretended to cough and sneeze to show that we were “sick,” sprinkled glitter on our hands, and held our hands up to show the “germs” to the class (the French word for glitter, scintillement, sounds like you’re sneezing when you say it anyway—hooray for onomatopoeias!). We walked around the classroom, shaking hands with the students (on Friday, we picked two students to do this instead of us, to involve as many students as possible), and then we asked them to hold up their hands to see who else got the “germs.”

We then demonstrated proper hand washing technique and walked around the classroom with a basin of water and soap so they could each wash the glitter off their hands. The first graders had a little less hand-eye coordination, so my arms and legs were also washed 🙂

All of the grades remembered the hand washing song that Tiffany and Meagan taught last year, and I thought the song was a great way for the students to associate Kelly and me with last year’s interns.

When we asked, “When should you wash your hands?” and “Why should you wash your hands?,” I noticed that the students are used to answering in unison, not raising their hand and being called on individually. In the 5^th grade class on Friday, we tried to convey to our translator to call on one student to answer the question, but he picked random students to answer, rather than asking for volunteers to answer the question. While this method may keep the students on their toes and paying attention, we don’t want to create a fearful or negative learning environment.

So we have several cultural barriers to overcome, not only with the students but with the translator as well. Overall, though, I was very happy with the lessons so far, and now I have a better sense of the students’ level of understanding and how they tend to learn.

Between the 4^th and 2^nd grade lessons, we met briefly with the teachers and discussed what science/health material their students have or haven’t covered. While we gained some useful information, the purpose of the meeting was more to show the teachers that we don’t want to push our lessons on their students, but rather work with them and improve the material they’re already teaching.

In the afternoon, we went over to the clinic (which can be seen from the school) and met with Nadia, the dentist, and Dr. Lucien.

We demonstrated the Diagnostic Lab-in-a-Backpack, including how to charge the centrifuge, microscope, and battery charger for the otoscope and ophthalmoscope batteries with the lithium ion battery, solar panel, or wall outlet. They were especially impressed with the various charging options, as the clinic only recently got power. We also demonstrated the pulse oximeter and glucometer. One of the technicians pointed out that they quickly run out of the glucometer test strips, and I explained that reusable test strips were in development at Rice.

The most exciting part of the day for me was demonstrating the ophthalmology pack to Dr. Lucien. While the pack is still very much in development, it was great to finally show the results of two semesters’ worth of work!

For those of you who have not followed every iteration of the pack’s design (comparable to watching a tennis ball during a tennis match… head-spinning and nearly impossible!), the pack is currently intended for mobile ophthalmic diagnostic applications. Basically, an ophthalmologist can take the pack to rural, outlying areas, seek out patients in need of eye care, diagnose their condition, and refer them to the clinic for further, possibly surgical, treatment. The pack includes a portable indirect ophthalmoscope, a portable slit lamp, loupes, a condensing lens, vision charts, eye patches, syringes, needles, and various medications.

Because glaucoma is highly prevalent, even in young people, in Terrier Rouge, a tonometer is also needed to measure the intraocular eye pressure, but the version we originally ordered is more time-consuming than automated versions, so we chose to omit a tonometer for now.

Dr. Lucien told us about the surgeries she and Dr. Brown, an ophthalmologist from South Carolina who has extensive experience working in developing countries, performed a few weeks ago, and I could see how passionate she is about her work here. When they first began to seek out patients, she wasn’t sure how long it would take to find someone they could treat, but she almost immediately came across a man standing under a tree who had clouded lenses. His pupils responded to light, which indicated that he wasn’t permanently blind but had treatable cataract! She said that they spent a week finding and diagnosing patients, and another week performing over 40 surgeries! I can’t wait to see (ha ha) where our work with Dr. Lucien takes us this summer.

On Friday, we demonstrated the Community Health worker backpack to Dr. Gustav, the GP of the clinic. We were told that some of the components were too advanced for the clinic’s “agent sante” (health agent/worker), but we explained that the feedback forms will help us improve the backpack. I think one of the most challenging parts of demonstrating the 3 backpacks was to accurately convey that they are in development, and that we anticipate and need both positive and negative feedback and suggestions for improvement.

So that’s mainly what I’ve been up to for the past few days. Kelly and I also began Creole lessons with a local high schooler, Lanaud, who befriended the interns last year and is quickly becoming our friend and unofficial translator as well. I emailed him a few times this past spring, and seeing my email address written in the front of his Creole book put a smile on my face 🙂

In other news, the electricity was on and off all last evening (Kelly and I were joking that because we left the fan on all afternoon, we used up all of the electricity stored in the solar panels… our bad!), but on the plus side, we got to see the stars in their full glory.

Wow—the past two days have felt like a year. I’ll try to remember everything that’s happened, but I’m realizing how difficult it’s going to be to put my time in Haiti into words.

First of all, Haiti is absolutely beautiful. I knew Terrier Rouge was near the coast, and the terrain is fairly flat in the town, but I did not expect to see the mountains in the distance. The environment reminds me of a combination of the three places I’ve lived: the climate of Houston, the lushness of Pennsylvania, and the mountains of southeast Arizona. I’ve been to a few Caribbean islands before, and Haiti has the most unique terrain of any island I’ve seen.

We arrived in Cap Haitien early yesterday morning and were promptly greeted by Dr. Lucien, the ophthalmologist who works in both Cap Haitien and Terrier Rouge. It was great to finally meet her! She helped us get through customs smoothly and uneventfully. I was worried about the eye medications we were transporting; my mom told me that when she came through Port au Prince with a team of physical therapists and nurses, a lot of expensive medication that they brought was thrown out because the bottles had old expiration dates, even though the medicine hadn’t expired. So I’m very thankful that all of the equipment and medicine made it through customs.

Driving out of Cap Haitien and on to Terrier Rouge was definitely eye-opening. It’s hard to believe that a place like Haiti exists only a few hours from the U.S by plane. I think there’s a huge misconception that we, as Americans, have to travel halfway around the world to see extreme poverty, but it’s really in our own backyard.

When we arrived at St. Barthelemy, I was astounded at its size. It’s like a grand, white beacon in the town, and I could immediately sense the pride that the community has for the school. At three stories tall, it’s one of the largest buildings I’ve seen in Haiti so far.

After the children’s daily meal, we got to interact with them a little bit—they are absolutely adorable! A few kids came over to see Kelly and me at first, and about 2 minutes later, they were swarming all around us. I think I had at least 5 kids latched on to me at all times. They were holding my hands, looking at my fingernails, asking “Comment t’appelle tu?” (which means “what is your name?” in French). The school administrator had said that we were “en stage” (meaning “on stage”) before we even met the children, and he couldn’t have described our first meeting with them more accurately. With 20 sets of eyes looking up at me, I totally forgot at first that they speak some French, but then I tried to speak with them a little. Hopefully my years of high school French will come back to me—I knew I took it for a reason!

Speaking of names, my name has put me in a funny situation, as “Jocelyn” is a male name in French. Several people I’ve been emailing thought I was a man! So for the next two months, I’m going by “Jo (sounds like Joe with a soft J)-ce-line” to make my name more feminine. For the first time in my life, people can actually pronounce/understand my name—it’s great! We’ve met so many people at the school already and everyone has such interesting names.

After lunch, we met our translator, and he invited us to his house to meet his wife. They were so welcoming and gracious. We continued to walk around town for a while, and saw a crowd of people returning from a funeral. Our translator said that a young woman, only 26 years old, had passed away suddenly. Some of the kids were wearing white at school because they were mourning their family member’s death.

Today, I woke up to the rooster (no joke) outside of our window. Kelly and I have already named him Maurice. Contrary to popular belief, roosters do not only crow in the morning, but pretty much all night too. Bring it on, Maurice.

We first met the local education inspectors (the “inspectrice” and “inspecteur”… the French version of the word sounds much cooler), and we found out that the 6^th graders have to take exit exams before the end of the year. We’re not sure if these exams are used just to gauge the students’ knowledge, or to decide who continues on to secondary education, but the 6^th grade class we observed was hard at work to prepare for the test.

The school director took us around to meet all of the teachers in their classrooms, and I was amazed at how disciplined the kids were. I’m pretty sure a room filled with 40 American 3-year-olds would not be nearly as calm and behaved as the room we saw. When we walked into the upper-level classes, the students stood up and said “Bonjour” in unison, and some classes even sang a little song that went something like: “Bienvenue à vous, nous sommes heureux que vous êtes ici” (something like, welcome, we are happy that you’re here).

After lunch, we played jump rope with the kids for a while, which felt much more natural than staring at each other and smiling.

We also watched the music class practice a song on their recorders for a few minutes. The teacher was very serious and focused, and the students both sang and played the song written on the board. I could totally see my sister Claudia, who is a music education and voice major, up in front of the room, singing and pointing at the music 🙂

The pace around here is much slower than the usual frantic American pace, so I’m still adjusting and accepting the fact that what we aim to accomplish in a day and what we actually accomplish might be very different. It’s funny how much the weather affects me—being motivated to work is much harder in the mid-day heat, compared to the afternoon and evening coolness. I’m currently sitting on our porch, watching the huge thunderclouds and lightning in the distance. I couldn’t ask for a better blogging spot!

Kelly and I have begun to plan our first lesson for tomorrow, and we’re hoping to review Tiffany and Meagan’s lessons as well as include some new concepts. Tomorrow will probably be a much greater learning experience for me than the students!